New metrics needed to visualize the long-term impact of early LDL-C lowering on the cardiovascular disease trajectory.

Short-term absolute cardiovascular event rates in young/middle-aged people are low even if they have risk factors, and parameters such as number-needed-to-treat over 5years are inadequate to visualize and to communicate the lifelong benefit of interventions such as statin therapy to individuals and to healthcare providers. To understand more fully the impact of risk factors, and lifestyle and pharmacological interventions, there is a need to focus on disease trajectory over a lifetime and to develop new metrics of success. A shift to primordial ('true') prevention of the formation of atherosclerotic lesions will require new tools and approaches in the interaction between physicians and patients as individuals or populations.